Infections of cardiac implantable electronic devices: epidemiology, mechanisms and preventive measures.

Abstract

Cardiac implantable electronic devices (CIED) infections represent a complication associated with high morbidity and mortality. Despite enormous efforts to prevent them, the rates of infections continue to rise out of proportion to the reported increase in CIED implantation rates. Following extensive research of various prevention strategies and new technologies, several organizations have issued recommendations and consensus papers covering the topic. The aim of this narrative review is to provide a summary of the existing preventive strategies put forward by the European Heart Rhythm Association consensus document, and European Society of Cardiology guidelines and introduce the most recent developments in the field, including optimized surgical site management and appropriate periprocedural antithrombotic drugs use. It also provides an overview of epidemiology, mechanisms, risk factors, and risk stratification approaches. It focuses on the pre-, intra-, and postprocedural actions to be taken in order to mitigate CIED infection risks. Future directions in the prevention of CIED infections have also been addressed.